| NPI | 1730704776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 61320957) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001010918) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2022-10-01 |